Methicillin (oxacillin)-resistant Staphylococcus aureus (MRSA) is by far the most common resistant bacterial pathogen. Despite concerted efforts to decrease transmission, the prevalence of this organism continues to increase in healthcare facilities and in the community. Moreover, this organism now causes serious infections in persons who do not have the traditional risk factors for MRSA infections and it can spread silently in the healthcare setting and in the community. Few hospitals have implemented all components of the evidence-based guidelines for preventing spread of MRSA. The purpose of the proposed study is to 1) encourage all Iowa hospitals to implement the Institute for Healthcare Improvement's (IHI) MRSA bundle and to report data on nosocomial MRSA infections to Iowa's unique voluntary reporting system for healthcare-associated infections; 2) identify impediments and/or facilitators to successful translation of this evidence-based public health guideline; 3) identify optimal strategies for enhancing widespread adoption and institutionalization of this effective public health intervention. A robust coalition of specialists in implementation of evidence-based guidelines, quality improvement, infectious diseases, microbiology, molecular epidemiology, hospital epidemiology, public health, healthcare delivery, and healthcare policy will study the implementation of this evidence-based guideline to control MRSA. This proposal has 6 specific aims: 1) Assess knowledge, current preventive practices, and needs regarding MRSA control in acute-care hospitals, long-term-care facilities, and in the outpatient setting; 2) Implement IHI's MRSA bundle at the University of Iowa Hospitals and Clinics, the Iowa City Veterans Affairs Medical Center, and at acute care hospitals across Iowa; 3) Determine whether MRSA carriage at sites other than the nares, carriage by healthcare workers, and environmental contamination decreases the effectiveness of IHI's MRSA Bundle; 4) Assess the implementation of IHI's MRSA Bundle in individual hospitals and in Iowa's hospitals in general; 5) Assess the effectiveness of IHI's MRSA bundle at individual hospitals and in Iowa's hospitals in general; 6) Develop resources to help the community prevent spread of MRSA; control of MRSA in the community might enhance the effectiveness of IHI's MRSA bundle in hospitals. The methods will involve observing practice, calculating rates of nosocomial MRSA bloodstream infections and of MRSA transmission, feeding these rates back to the clinicians, evaluating progress, implementing more change, and measuring rates again (rapid-cycle change). Statistical analysis will be done by time series analysis methods adapted for data with frequent zeros to assess whether implementing the evidence-based guideline was successful. Summative surveys and focus groups, using methods from appreciative inquiry, positive deviance, and critical incident analysis, will be conducted to identify facilitators and obstacles to implementation. Methicillin-resistant Staphylococcus aureus (MRSA), which is the most common resistant bacteria causing serious infections in both healthy people and people whose immune systems are impaired, continues to spread in healthcare facilities and in the community. Yet numerous studies have demonstrated that concerted efforts, particularly in hospitals, can decrease MRSA infections and prevent spread of this organism. The goal of this proposal is to implement these effective practices in hospitals and in high risk areas of the community across Iowa to prevent MRSA infections and to learn how best to translate medical knowledge into everyday medical practice. [unreadable] [unreadable] [unreadable]